Survival of Patients with Chronic Total Occlusion of the Right Coronary Artery
Hussein Sliman1, Moshe Y Flugelman1, Idit Lavi2
1Department of Cardiology, Carmel Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Insights
Revascularization for coronary chronic total occlusion (CTO) in the right coronary artery (RCA) did not independently predict survival in patients with isolated RCA CTO. Further analysis identified age, kidney function, and ejection fraction as key mortality predictors.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- The impact of revascularizing coronary chronic total occlusions (CTOs) on patient survival remains uncertain.
- Previous studies suggested improved survival with CTO revascularization but lacked uniform patient selection.
- Confounding factors like comorbidities and disease extent made it difficult to isolate CTO revascularization's true effect.
Purpose of the Study:
- To investigate the association between successful CTO revascularization and survival in patients with a specific, uniform coronary anatomy.
- To focus on patients with isolated CTO of the right coronary artery (RCA) to minimize confounding variables.
Main Methods:
- Analysis of a registry of 16,832 coronary angiograms to identify patients with isolated RCA CTO.
- Comparison of survival outcomes between 52 patients who underwent successful percutaneous coronary intervention (PCI) and those who did not.
- Extended follow-up to assess long-term mortality.
Main Results:
- Patients who underwent revascularization were younger and had better kidney function and fewer comorbidities.
- Lack of CTO revascularization was a univariable predictor of mortality.
- Multivariable analysis identified older age, reduced creatinine clearance, and low ejection fraction as independent predictors of mortality.
Conclusions:
- In patients with isolated RCA CTO, successful revascularization was not an independent predictor of increased survival.
- Age, kidney function, and ejection fraction were the primary determinants of mortality in this patient cohort.
Background:
The impact of revascularization of coronary chronic total occlusion (CTO) on survival is unknown. Several studies, which included subjects with varied coronary anatomy, suggested that CTO revascularization improved survival. However, the contribution of CTO revascularization to improved outcome is unclear since it was more commonly achieved in subjects with fewer co-morbidities and less extensive coronary disease.
Objectives:
To study the association between CTO revascularization and survival in patients with uniform coronary anatomy consisting of isolated CTO of the right coronary artery (RCA).
Methods:
A registry of 16,832 coronary angiograms was analyzed. We identified 278 patients (1.7%) with isolated CTO of the RCA who did not have lesions within the left coronary artery for which revascularization was indicated. Survival of 52 patients (19%) who underwent successful percutaneous coronary intervention was compared to those who did not receive revascularization.
Results:
Revascularized patients were younger (60.2 vs. 66.3 years, P = 0.001), had higher creatinine clearance (106 vs. 83 ml/min, P < 0.0001), and had fewer co-morbidities than those who did not receive revascularization. Lack of CTO revascularization was a univariable predictor of mortality (hazard ratio [HR] = 2.65, 95% confidence interval [95%CI] 1.06-6.4) over 4.3 ± 2.5 years of follow-up. On multivariable analysis, the only predictors of mortality were increased age (HR 1.04, 95%CI 1.01-1.07), reduced creatinine clearance (HR 1.02, 95%CI 1.01-1.03), and ejection fraction below 55% (HR 2.24, 95%CI 1.22-4.11).
Conclusions:
Among patients with isolated RCA CTO who underwent extended follow-up, revascularization was not an independent predictor of increased survival.
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